Complete excision of the infrapatellar fat pad is associated with patellar tendon shortening after primary total knee arthroplasty

被引：29
作者：
Gwyn R. [1 ,3 ]
Kotwal R.S. [2 ]
Holt M.D. [2 ]
Davies A.P. [2 ]
机构：
[1] Royal Gwent Hospital, Newport
[2] Morriston University Hospital, Swansea
[3] Bryn Deri, 440 Birchgrove Road, Birchgrove, Swansea
来源：
European Journal of Orthopaedic Surgery & Traumatology | 2016年 / 26卷 / 5期
关键词：
Infrapatellar fat pad; Knee arthroplasty; Patella baja; Patellar tendon shortening;
D O I：
10.1007/s00590-016-1775-x
中图分类号：
学科分类号：
摘要：
Background: Patella baja is a potentially disabling and difficult-to-treat complication following total knee arthroplasty (TKA). We investigated whether complete or partial excision of the fat pad has an effect on the length of the patellar tendon following TKA. Methods: A retrospective review of patient radiographs was performed. One hundred and eleven consecutive patients who underwent primary TKA for osteoarthritis using the same components by two consultants were selected. Seventy-two patients underwent complete excision of the fat pad, whilst 39 had partial excision as per consultant practice. Patellar height was measured using the Caton–Deschamps Index (CDI) on immediate postoperative radiographs and at a minimum follow-up of 1 year. Results: In the complete excision group, the mean CDI changed from 0.54 immediately postoperatively to 0.45 at a minimum follow-up of 1 year (p < 0.0001) indicating shortening of the patellar tendon, and eight patients reported anterior knee pain. The partial excision group’s mean CDI changed from 0.76 to 0.75 (p = 0.231). An analysis of variance showed that the effect of complete fat pad excision on patella tendon length was significant, F(1, 109) = 15.273, p < 0.001. Conclusion: At a minimum follow-up of 1 year, the patellar tendon length shortened significantly in the group of patients with complete fat pad excision. With partial excision, there was no significant change in tendon length. Complete excision of the fat pad should therefore be avoided wherever possible in an attempt to avoid patella baja. Level of evidence: II. © 2016, Springer-Verlag France.
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页码：545 / 549
页数：4
相关论文
共 28 条
  • [11] Ushiyama T., Chano T., Inoue K., Matsusue Y., Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids, Ann Rheum Dis, 62, 2, pp. 108-112, (2003)
  • [12] Liu Y.P., Li S.Z., Yuan F., Xia J., Yu X., Liu X., Yu G.R., Infrapatellar fat pad may be with tendon repairing ability and closely related with the developing process of patella baja, Med Hypotheses, 77, 4, pp. 620-623, (2011)
  • [13] Wickham M.Q., Erickson G.R., Gimble J.M., Vail T.P., Guilak F., Multipotent stromal cells derived from infrapatellar fat pad of the knee, Clin Orthop Relat Res, 412, pp. 196-212, (2003)
  • [14] Caton J., Deschamps G., Chambat P., Lerat J.L., Dejour H., Patella infera: a propos of 128 cases, Rev Chir Orthop Reparatrice Appar Mot, 68, pp. 317-325, (1982)
  • [15] Phillips C.L., Silver D.A., Schranz P.J., Mandalia V., The measurement of patellar height: a review of the methods of imaging, J Bone Joint Surg Br, 92, 8, pp. 1045-1053, (2010)
  • [16] Scapinelli R., Blood supply of the human patella. Its relation to ischaemic necrosis after fracture, J Bone Joint Surg Br, 49, 3, pp. 563-570, (1967)
  • [17] Kayler D.E., Lyttle D., Surgical interruption of patellar blood supply by total knee arthroplasty, Clin Orthop, 229, (1988)
  • [18] Bryan R.S., Patella infra and fat pad hypertrophy after total knee arthroplasty, Tech Orthop, 3, (1988)
  • [19] Insall J., Salvati E., Patella position in the normal knee joint, Radiology, 101, pp. 101-104, (1971)
  • [20] Grelsamer R.P., Meadows S., The modified Insall–Salvati ratio for assessment of patellar height, Clin Orthop, 282, pp. 170-176, (1992)
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